Treating CAD, The Right Way...

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Chest Pain

Here's an insight into CAD (Heart Diseases) and its treatment both individualized and balanced...

Coronary Artery Disease (CAD) is the entity in which the arteries which supply blood to the heart muscle get the deposition of calcium and cholesterol, leading to plaque and atheroma formation.
The leading causes are smoking, excessive alcohol, diabetes, hypertension, high cholesterol in the blood, mental stress.
Symptoms depend upon the extent, intensity, and acuteness of blockages.
Chronic Stable Angina is the term used for symptoms of chest heaviness, breathlessness sweating may be associated with suffocation on activity, which typically resolves on rest.
It may become unstable when either the intensity or frequency increase or the symptoms start to occur either at less activity or even rest. 
The acute heart attack is the term used for similar symptoms at rest which doesn't resolve with the usual medication.
Treatment of these is standard, though has to be individualized depending upon the extent, type of disease.
The modalities include-

  • Lifestyle modification and medication
  • Lifestyle modification and intervention
  • Lifestyle modification and non-interventional therapeutic

An acute heart attack is an emergency and needs to be treated like one. Either injections to open-up the blocked artery or balloon angioplasty with stenting are the best options.

Stable CAD patients can be taken up for angioplasty with stenting for discrete lesions, bypass for lesions not amenable to angioplasty and ECP (External Counter Pulsation) for patients unfit for bypass and lesions unsuitable for angioplasty.
You have angina not adequately relieved by medications. You have recurrent evidence of fluid retention and dyspnoea (breathlessness) due to weak heart functions. You have already undergone invasive procedures, but chest pain remains or comes back. Your cardiologist has determined that you are no longer a candidate for any invasive procedure or the risk involved is too much to take. You can be a candidate for Enhanced External Counter Pulsation (EECP).

EECP is a non-invasive, outpatient treatment for heart disease that is used to relieve or eliminate angina. During the treatment, blood pressure cuffs are wrapped around your legs, and squeeze and release in sync with your heartbeat, promoting blood flow throughout your body and particularly to your heart. In the process, EECP develops new pathways around blocked arteries in the heart by expanding networks of tiny blood vessels (" collaterals") that help increase and normalize blood flow to the heart muscle. For this reason, it is often called the natural bypass.

The standard course of treatment is one hour per day, five days per week, for seven weeks (a total of 35 one-hour sessions). Some patients have two treatments in one day in order to complete the program more quickly. Some patients extend the program beyond 35 treatments, depending on their medical situation and goals.
Most patients begin to experience beneficial results from EECP between their 15th and 25th day of treatment. These benefits include increased stamina, improved sleeping patterns, decreased angina, and less reliance on nitro-glycerine and other medications. There is variation, certainly, and some patients start to feel better as soon as in their first week of treatment! 

With an ever-increasing incidence of heart disease, lots of innovations happening in the treatment modalities, the patients of stable angina, heart failure now have EECP to relieve their symptoms on the outdoor basis.

Originally published in Times of India (29-Sep-2018)

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